Field of the Invention
The present invention relates generally to systems and methods for monitoring sleep, and more particularly to systems and methods that provide monitoring of a person's sleep, and sleep related activities and utilizing cognitive behavior therapy.
Description of the Related Art
More than 40 million Americans suffer from chronic, long-term sleep disorders, and an additional 20 million report sleeping problems occasionally. Stress and anxiety may cause sleeping problems or make existing problems worse. Having an anxiety disorder exacerbates the problem.
Sleep disorders are characterized by abnormal sleep patterns that interfere with physical, mental, and emotional functioning. Stress or anxiety can cause a serious night without sleep, as do a variety of other problems.
Insomnia is the clinical term for people who have trouble falling asleep, difficulty staying asleep, waking too early in the morning, or waking up feeling un-refreshed.
Other common sleep disorders include sleep apnea (loud snoring caused by an obstructed airway), sleepwalking, and narcolepsy (falling asleep spontaneously). Restless leg syndrome and bruxism (grinding of the teeth while sleeping) are conditions that also may contribute to sleep disorders.
Anxiety causes sleeping problems, and new research suggests sleep deprivation can cause an anxiety disorder.
Some form of sleep disruption is present in nearly all psychiatric disorders. People with chronic insomnia are at high risk of developing an anxiety disorder.
The risks of inadequate sleep extend way beyond tiredness. Sleeplessness can lead to poor performance at work or school, increased risk of injury, and health problems.
In addition to anxiety and mood disorders, those with sleep disorders are risk for heart disease, heart failure, irregular heartbeat, heart attack, high blood pressure, stroke, diabetes, and obesity.
Cognitive behavioral therapy (CBT) is a form of psychotherapy. It was originally designed to treat depression, but is now used for a number of mental disorders. It works to solve current problems and change unhelpful thinking and behavior. The name refers to behavior therapy, cognitive therapy, and therapy based upon a combination of basic behavioral and cognitive principles.
Most therapists working with patients dealing with anxiety and depression use a blend of cognitive and behavioral therapy. This technique acknowledges that there may be behaviors that cannot be controlled through rational thought, but rather emerge based on prior conditioning from the environment and other external and/or internal stimuli. CBT is “problem focused” (undertaken for specific problems) and “action oriented” (therapist tries to assist the client in selecting specific strategies to help address those problems), or directive in its therapeutic approach.
CBT is effective for a variety of conditions, including mood, anxiety, personality, eating, addiction, dependence, tic, insomnia and psychotic disorders. Many CBT treatment programs have been evaluated for symptom-based diagnoses and been favored over approaches such as psychodynamic treatments. However, other researchers have questioned the validity of such claims to superiority over other treatments.
CBT has been shown to be effective in the treatment of adult anxiety disorders, insomnia and the like.
A basic concept in some CBT treatments used in anxiety disorders is in vivo exposure. The term refers to the direct confrontation of feared objects, activities, or situations by a patient. For example, a woman with PTSD who fears the location where she was assaulted may be assisted by her therapist in going to that location and directly confronting those fears. Likewise, a person with social anxiety disorder who fears public speaking may be instructed to directly confront those fears by giving a speech. Through exposure to the stimulus, this harmful conditioning can be “unlearned” (referred to as extinction and habituation). Studies have provided evidence that when examining animals and humans that glucocorticoids may possibly lead to a more successful extinction learning during exposure therapy. For instance, glucocorticoids can prevent aversive learning episodes from being retrieved and heighten reinforcement of memory traces creating a non-fearful reaction in feared situations. A combination of glucocorticoids and exposure therapy may be a better improved treatment for treating patients with anxiety disorders.
One type of CBT program includes face-to-face sessions between patient and therapist, made up of 6-18 sessions of around an hour each with a gap of 1-3 weeks between sessions. This initial program can be followed by some booster sessions, for instance after one month and three months. CBT has also been found to be effective if patient and therapist type in real time to each other over computer links.
Cognitive behavioral therapy is most closely allied with the scientist-practitioner model in which clinical practice and research is informed by a scientific perspective, clear operationalization of the problem, and an emphasis on measurement, including measuring changes in cognition and behavior and in the attainment of goals. These are often met through “homework” assignments in which the patient and the therapist work together to craft an assignment to complete before the next session. The completion of these assignments—which can be as simple as a person suffering from depression attending some kind of social event—indicates a dedication to treatment compliance and a desire to change. The therapists can then logically gauge the next step of treatment based on how thoroughly the patient completes the assignment. Effective cognitive behavioral therapy is dependent on a therapeutic alliance between the healthcare practitioner and the person seeking assistance. Unlike many other forms of psychotherapy, the patient is very involved in CBT. For example, an anxious patient may be asked to talk to a stranger as a homework assignment, but if that is too difficult, he or she can work out an easier assignment first. The therapist needs to be flexible and willing to listen to the patient rather than acting as an authority figure.
Computerized cognitive behavioral therapy (CCBT) is a term for delivering CBT via an interactive computer interface delivered by a personal computer, internet, or interactive voice response system instead of face-to-face with a human therapist. It is also known as internet-delivered cognitive behavioral therapy or ICBT. CCBT can be used to improve access to evidence-based therapies, and to overcome the prohibitive costs and lack of availability sometimes associated with retaining a human therapist.
The prevalence of chronic insomnia is as high as 30%, but estimates range considerably, depending on the criteria used to define insomnia and the sample population used. Insomnia has also been associated with high levels of healthcare utilization, and increased direct and indirect healthcare costs. A diagnosis of insomnia is typically established through assessment by an experienced clinician. Several efficacious treatments for insomnia, such as cognitive behavioral therapy (CBT), exist. Yet wait times and lack of access to insomnia specialists can be a barrier to diagnosis and treatment. Moreover, insomnia may occur independently, or may coexist with other sleep disorders, which can complicate diagnosis and treatment. Screening tools that can accurately and reliably identify primary insomnia could help from a triage standpoint, as they may direct newly referred patients to the appropriate specialists and/or diagnostic testing. In a research setting, an insomnia screening tool would be desirable for case finding. While a breadth of insomnia questionnaires and screening tools exist, most of these tools were developed for use in large epidemiologic studies and lack validation in a clinic setting. Moreover, very few have used a clinician defined reference standard for insomnia.
A key issue in CCBT use is low uptake and completion rates, even when it has been clearly made available and explained.